This invention is in the field of human medicine, particularly in the treatment of vascular disorders with activated protein C. More specifically, the present invention relates to formulations of activated human protein C.
Protein C is a serine protease and naturally occurring anticoagulant that plays a role in the regulation of homeostasis by inactivating Factors Va and VIIIa in the coagulation cascade. Human protein C is made in vivo primarily in the liver as a single polypeptide of 461 amino acids. This single chain precursor molecule undergoes multiple post-translational modifications including 1) cleavage of a 42 amino acid signal sequence; 2) proteolytic removal from the one chain zymogen of the lysine residue at position 156 and the arginine residue at position 157 to make a 2-chain zymogen form of the molecule, (i.e., a light chain of 155 amino acid residues attached through a disulfide bridge to the serine protease-containing heavy chain of 262 amino acid residues); 3) vitamin K-dependent carboxylation of nine glutamic acid residues clustered in the first 42 amino acids of the light chain, resulting in nine gamma-carboxyglutamic acid residues; and 4) carbohydrate attachment at four sites (one in the light chain and three in the heavy chain). The heavy chain contains the well established serine protease triad of Asp 257, His 211 and Ser 360. Finally, the circulating 2-chain zymogen is activated in vivo by thrombin at a phospholipid surface in the presence of calcium ion. Activation results from removal of a dodecapeptide at the N-terminus of the heavy chain, producing activated protein C (aPC) possessing enzymatic activity.
In addition to the enzymatic activities of aPC within the blood coagulation cascade, aPC also can autodegrade, leading to decreased functionality as an anticoagulant. Applicants have discovered an important degradation pathway. Autodegradation of the N-terminus of the light chain may result in a clip on either side of the histidine residue at position 10. Thus, this degradation pathway yields two inactive products: 1) des(1-9) activated protein C, wherein the first nine N-terminal residues of the light chain have been removed; and 2) des(1-10) activated protein C, wherein the first ten N-terminal residues of the light chain have been removed. This degradation pathway, which has not been previously reported, results in loss of anticoagulant activity due to the removal of the critical GLA residues at positions 6 and 7. Therefore, minimizing the level of the des(1-9) and des(1-10) activated Protein C autodegradation products is important in achieving a potent, high purity, activated protein C pharmaceutical formulation. These variants were previously unknown degradation products and are exceedingly difficult, if not impossible, to remove by conventional purification techniques. Applicants have further discovered that solid-state solubility is significantly enhanced in the presence of a select group of bulking agents.
It is clearly desirable to minimize such degradation of activated protein C in both the solution and lyophilized solid states. Accordingly, these discoveries allow the preparation of potent, high purity, activated protein C formulations which are pharmaceutically elegant to the health care provider.
The present invention provides improved formulations of activated protein C substantially free of such autodegradation products, particularly, des(1-9) and des(1-10) forms of the light chain of activated protein C. Therefore, said formulations are suitable for administration to a patient in need thereof.
The present invention provides a stable lyophilized formulation comprising activated protein C and a bulking agent selected from the group consisting of mannitol, trehalose, raffinose, sucrose, and mixtures thereof.
The present invention also provides a stable lyophilized formulation comprising about 2.5 mg/mL activated protein C, about 15 mg/mL sucrose, and about 20 mg/mL NaCl. Furthermore, the present invention provides a stable lyophilized formulation comprising about 5 mg/mL activated protein C, about 30 mg/mL sucrose, and about 38 mg/mL NaCl.
The present invention also provides a process for preparing a formulation comprising activated protein C and a bulking agent selected from the group consisting of mannitol, trehalose, raffinose, and sucrose and mixtures thereof.
The invention also provides a unit dosage form comprising a unit dosage receptacle containing the formulation wherein the weight to weight ratio is about 1 part activated protein C, about 7.6 parts salt and about 6 parts bulking agent.
The invention further provides a method of treating disease states involving intravascular coagulation comprising the administration of a formulation of activated protein C described herein.
For purposes of the present invention, as disclosed and claimed herein, the following terms are as defined below.
aPC or activated protein C refers to activated protein C whether recombinant or plasma derived. aPC includes and is preferably human activated protein C although aPC may also include other species or derivatives having protein C proteolytic, amidolytic, esterolytic, and biological (anticoagulant or pro-fibrinolytic) activities. Examples of protein C derivatives are described by Gerlitz, et al., U.S. Pat. No. 5,453,373, and Foster, et al., U.S. Pat. No. 5,516,650, the entire teachings of which are hereby incorporated by reference.
APTTxe2x80x94activated partial thromboplastin time.
r-hPCxe2x80x94recombinant human protein C zymogen.
r-aPCxe2x80x94recombinant activated protein C produced by activating protein C zymogen in vitro or in vivo or by direct secretion of the activated form of protein C from procaryotic cells, eukaryotic cells, or transgenic animals including, for example, secretion from human kidney 293 cells as a zymogen then purified and activated by techniques well known to the skilled artisan and demonstrated in Yan, U.S. Pat. No. 4,981,952, and Cottingham, WO 97/20043, the entire teachings of which are herein incorporated by reference.
Continuous infusionxe2x80x94continuing substantially uninterrupted the introduction of a solution into a blood vessel for a specified period of time.
Bolus injectionxe2x80x94the injection of a drug in a defined quantity (called a bolus) at once.
Suitable for administrationxe2x80x94a lyophilized formulation or solution that is appropriate to be given as a therapeutic agent.
Zymogenxe2x80x94protein C zymogen, as used herein, refers to secreted, inactive forms, whether one chain or two chains, of protein C.
Pharmaceutically acceptable bufferxe2x80x94a pharmaceutically acceptable buffer is known in the art. Pharmaceutically acceptable buffers include sodium phosphate, sodium citrate, sodium acetate, or TRIS.
Activated protein C is an antithrombotic agent with a wider therapeutic index than available anticoagulants, such as heparin and the oral hydroxycoumarin type anticoagulants. As an antithrombotic agent, aPC has a profound effect on the treatment of a wide variety of acquired disease states involving intravascular coagulation, including thrombotic stroke, deep vein thrombosis, pulmonary embolism, peripheral arterial thrombosis, emboli originating from the heart or peripheral arteries, acute myocardial infarction, disseminated intravascular coagulation, and acute pre or postcapillary occlusions, including transplantations or retina thrombosis.
The present invention relates to formulations of activated protein C. The desired formulation would be one that is a stable lyophilized product of high purity consisting of activated protein C and a bulking agent selected from the group consisting of mannitol, trehalose, raffinose, and sucrose. The lyophilized product is reconstituted with the appropriate diluent such as sterile water or sterile saline. Preferably, the resulting solution has a pH of about 5.5 to about 6.5.
The molecular interactions in a formulation between activated protein C, buffer, salt concentration, pH, temperature, and bulking agents, are complex, and the role that each factor contributes to the stability of the formulation is unpredictable. The lyophilized formulations of the present invention provide stable, enzymatically active, activated protein C upon resuspension because of reduced autodegradation. The present invention has particularly reduced levels of des(1-9) aPC and des(1-10) aPC. Generally, the levels of des(1-9) and des(1-10) aPC are less than 10% of the autodegradation product. Preferably, the levels of des(1-9) and des(1-10) aPC are less than 8% of the autodegradation product. Still more preferably, the levels of des(1-9) and des(1-10) aPC are less than 5% and most preferably less than 3% of the autodegradation product. This stability is obtained through careful control of the processing conditions and by the addition of sucrose, trehalose, raffinose, or mannitol. Interestingly, other bulking agents such as hydroxyethyl starch and glycine do not offer the necessary stability or pharmaceutical elegance.
The bulking agents of the present invention provide a pharmaceutically elegant formulation which has a uniform appearance and is readily solubilized when resuspended with the appropriate solute. Upon reconstitution, the formulation is stable for up to 24 hours to 48 hours at room temperature. Resulting in stability previously unachievable.
Preferred bulking agents in the formulation of activated protein C are sucrose, trehalose and raffinose. More preferred bulking agents are sucrose and raffinose and the most preferred bulking agent is sucrose. The amount of bulking agent in the formulation is 1 part aPC to 1 to 10 parts bulking agent on a weight to weight basis. Moreover, the bulking agent concentration of the formulation is an important formulation variable of the freeze drying process. The optimum concentration of bulking agent is dependent on the amount of aPC and species of bulking agent selected. The preferred concentration of sucrose in the freezing solution is 10 to 40 mg/mL. A more preferred concentration of sucrose is 15 to 30 mg/mL. The most preferred concentration of sucrose in the freezing solution is 15 mg/mL in a formulation of aPC at 2.5 mg/mL. The most preferred concentration of sucrose in the freezing solution is 30 mg/mL in a formulation of aPC at 5.0 mg/mL. The presence of the claimed bulking agent in the formulation of activated protein C offers increased chemical and physical stability.
Prior to freeze drying and upon reconstitution, it is preferable to maintain the pH in the range of 5.5 to 6.5 to minimize solution state autodegradation. The preferred pH of the formulation is a pH between about pH 5.6 and about pH 6.4. More preferred is a pH between about 5.7 to about 6.3. Even more preferred is a pH between about 5.8 to about 6.2. Still even more preferred is a pH between about 5.9 to about 6.1. The most preferred pH is about pH 6.0.
To maintain effective pH control, the aPC solution should contain a pharmaceutically acceptable buffer. Accordingly, upon freeze-drying, the formulation optionally and preferably comprises a pharmaceutically acceptable buffer. Representative buffer systems include Tris-acetate, sodium citrate, and sodium phosphate. More preferred buffer systems include sodium citrate and sodium phosphate. The most preferred buffer is sodium citrate. The preferred molarity of the buffer system is 10 mM to 50 mM. A more preferred molarity of the buffer system is 10 mM to 20 mM. The most preferred molarity is 40 mM. The skilled artisan will recognize that many other buffer systems are available which also can be used in the formulations of the present invention.
Similarly, during freeze drying and upon reconstitution, the ionic strength is a critical variable to ensure solution state stability. The ionic strength is generally determined by the salt concentration of the solution. Pharmaceutically acceptable salts typically used to generate ionic strength include but are not limited to potassium chloride (KCl) and sodium chloride (NaCl). The preferred salt in the present invention is sodium chloride. During freeze-drying, the salt concentration must be high enough to cause the salt to crystallize during the freezing step of the freeze-drying cycle. Preferably, the sodium chloride concentration is greater than 150 mM. More preferably, the sodium chloride concentration in the freezing solution is between 150 mM to 1000 mM. For a formulation containing 2.5 mg/mL aPC, the more preferable sodium chloride concentration in the freezing solution is between 150 mM to 650 mM. Even more preferably the sodium chloride concentration in the freezing solution is between 250 mM to 450 mM. Still even more preferably the sodium chloride concentration in the freezing solution is between 300 mM to 400 mM. The most preferable sodium chloride concentration in the freezing solution is 325 mM for a formulation containing 2.5 mg/mL aPC.
Similarly, for a formulation containing 5.0 mg/mL aPC, the more preferable sodium chloride concentration in the freezing solution is between 150 mM to 1000 mM. Even more preferably the sodium chloride concentration in the freezing solution is between 250 mM to 750 mM. Still even more preferably the sodium chloride concentration in the freezing solution is between 400 mM to 700 mM. The most preferable sodium chloride concentration in the freezing solution is 650 mM for a formulation containing 5.0 mg/mL aPC.
The ratio of aPC:salt:bulking agent (w:w:w) is an important factor in a formulation suitable for the freeze drying process. The ratio varies depending on the concentration of aPC, salt selection and concentration and bulking agent selection and concentration. One skilled in the art could readily identify the preferred ratio of aPC:salt:bulking agent by techniques appreciated in the art and described, for example, in Example 1. Particularly, a weight ratio of one part activated protein C to between about 7 to 8 parts salt to between about 5 to 7 parts bulking agent is preferred. More preferred is a weight ratio of one part activated protein C to between about 7.5 to about 8 parts salt to between about 5.5 to about 6.5 parts bulking agent. Most preferred is a ratio of about 1 part activated protein C to about 7.6 parts salt to about 6 parts bulking agent.
The preferred salt is sodium chloride at a concentration of 325 mM (for a formulation containing 2.5 mg/mL aPC) and 650 mM (for a formulation containing 5.0 mg/mL aPC) and at a ratio of about 1.3:1 with sucrose (w:w). This concentration is high enough to cause the salt to crystallize during the freezing process, most likely resulting in an amorphous mixture of aPC, sucrose, and citrate that can be lyophilized. Thus, the ionic strength of NaCl at the preferred concentrations of 325 mM and 650 mM convey a stability to the formulation during the freeze-drying process.
The present invention further provides a process for preparing a stable lyophilized formulation which comprises lyophilizing a solution comprising activated protein C and a bulking agent selected from the group consisting of mannitol, trehalose, raffinose, and sucrose, and mixtures thereof. The invention also provides a process for preparing a stable lyophilized formulation which comprises lyophilizing a solution comprising about 2.5 mg/mL activated protein C, about 15 mg/mL sucrose, about 19 mg/mL NaCl, and a sodium citrate buffer having a pH greater than 5.5 but less than 6.5. Furthermore, the present invention provides a process for preparing a stable lyophilized formulation which comprises lyophilizing a solution comprising about 5 mg/mL activated protein C, about 30 mg/mL sucrose, about 38 mg/mL NaCl, and a citrate buffer having a pH greater than 5.5 but less than 6.5.
The present invention provides a unit dosage form comprising a unit dosage receptacle containing a stable lyophilized formulation comprising activated protein C and a bulking agent selected from the group consisting of mannitol, trehalose, raffinose, and sucrose, and mixtures thereof. Furthermore, the present invention provides a method of treating disease states involving intravascular coagulation comprising the administration of said formulation.
The aPC is preferably administered parenterally to ensure its delivery into the bloodstream in an effective form by injecting the appropriate dose as continuous infusion for about one to about forty-eight hours. The amount of aPC administered is from about 0.01 mg/kg/hr to about 0.05 mg/kg/hr. Alternatively, the aPC will be administered by injecting a portion of the appropriate dose per hour as a bolus injection over a time from about 5 minutes to about 30 minutes, followed by continuous infusion of the appropriate dose for about twenty-three hours to about 47 hours which results in the appropriate dose administered over 24 hours to 48 hours.